Before Christmas Paula Jardine reported for TCW on the strange case of the South Pacific island nation of Samoa’s 2019 ‘lockdown’ and compulsory mass measles vaccination programme over a period which saw the deaths of 76 under-fives. Since then she has interviewed the Samoan businessman Edwin Tamasese who reported widespread measles outbreaks six to seven days post-vaccination, and who was subsequently arrested for distributing the Vitamin A the children needed to cope with either the vaccine or a measles infection. As Paula explained in her previous article, the high mortality was more likely to be due to a combination of malnutrition and an under-attenuated vaccine – that is, a vaccine where the virus had not been sufficiently weakened before being administered, as opposed to the disease itself. Here she reports Edwin Tamasese’s story.
SAMOA had suspended its measles, mumps and rubella (MMR) vaccination programme in July 2018 following the the internationally reported deaths of two babies given a vaccine incorrectly mixed by nurses with a muscle relaxant instead of saline solution. Tamasese invited Robert Kennedy Jr, chairman of the activist charity Children’s Health Defense, to Samoa in July 2019. As Kennedy would come only at the invitation of the government, Tamasese organised an invitation directly with the Samoan Prime Minister so that Kennedy could speak to him about vaccine safety. International health agencies, eager to hit MMR coverage targets after the programme was restarted in April 2019 are understood to have been pressuring the Samoan health ministry to restore confidence in the vaccine programme, fearing low uptake would otherwise remain the norm.
Two suspected measles cases reported in late August 2019 catalysed the government’s programme. Yet the first patient was a child returning from New Zealand who fully recovered. When a one-year-old boy died in hospital on October 15 a week after being admitted with a suspected case of measles, public health authorities declared an outbreak, blaming low vaccine uptake. The Samoan Ministry of Health began encouraging vaccination in earnest, disregarding the inconvenient fact that the victim had previously received a first dose of measles, mumps and rubella (MMR) vaccine.
Other victims are known to have been previously vaccinated, some twice, but unlike neighbouring Tonga, which also had a measles outbreak in 2019, Samoa never released any data on the vaccination status of the patients; in Tonga which Unicef reported had a 99 per cent measles vaccination coverage rate in 2018, 31 per cent of patients were twice vaccinated and a further 7 per cent had received a first dose, indicating that primary and secondary vaccine failure were factors in that outbreak.
Samoan businessman Edwin Tamasese realised there was a problem when an employee whose children were sick came to speak to him. Five children on the island had already died. Tamasese, on the parents’ behalf, took advice from doctors outside Samoa and was particularly concerned that the hospital had given paracetamol and antibiotics, both of which the scientific literature suggests can increase the complications in measles patients. The employee’s children were the first to be given vitamin A and vitamin C and recovered.
In an interview he told me: ‘There was another family I visited. The youngest kid, a nine-month-old boy, was very sick. They’d taken him to the hospital twice and been sent home. I gave the parents Vitamin A to give him and then Vitamin C to give him, 1 gram every two hours. The next day the kid was sitting up and eating. It was just amazing. Then the coconut wireless went crazy and I started getting phone calls from people asking for help.’
Knowing that there could be repercussions for his entire family for challenging the authorities, Tamasese first spoke to his parents asking for their permission to get involved, then had a discussion with his business partners. They all supported him.
‘The atmosphere definitely felt like the authorities wanted to make an example of Samoa,’ said Tamasese. ‘They just didn’t expect me to get in the middle of it.’ He began gathering data and as the vaccination campaign rolled out, the numbers of patients increased.
‘What I was seeing personally on the ground was that six to seven days post vaccination huge outbreaks were occurring in the villages that the vaccination vans were entering,’ said Tamasese. ‘We were very careful to take statistics when we were going in to try to identify trends. When we assessed our numbers, 98 per cent of those that were getting ill had been vaccinated consistently six to seven days prior to illness. The excuse was that the vaccine did not have time to become effective. However according to an immunologist on the team assisting, the six to seven-day period was also the length of time it would take an under-attenuated vaccine to make the recipient sick.’
Tamasese kept a screenshot of the Samoan Ministry of Health press release that preceded the official outbreak declaration on October 16, 2019. Of the first 36 samples taken from patients suspected of having measles, only seven were confirmed to be measles.
Samoa stopped laboratory testing of samples on November 22. The Ministry of Health had never actually stated that any of the deaths to that point were from confirmed measles cases, only that measles was suspected, but it certainly suited it to allow the idea to take hold that the deaths were due to measles.
In the end, nearly 39 per cent of laboratory-tested samples were found not to be measles, yet the children were still presenting with symptoms that doctors identified as measles. The symptoms of measles, rubella (German measles) and atypical measles (which occurs when vaccinated people are exposed to wild measles virus) are known to be difficult to distinguish from one another during an outbreak. A 2019 study found that the measles vaccine does not neutralise the D8 strain publicly linked to the Samoan outbreak very well.
‘Many of the sick children had throat swelling more consistent with mumps,’ said Tamasese. It looked as if a bad batch of vaccine was causing the sickness. On November 22, following the lead of nearby American Samoa, the government of Samoa declared a state of emergency, and made the vaccination programme compulsory. In the haste that followed, even children who were already showing measles symptoms or who were sick with other things were vaccinated, a factor that may have contributed to the unusually high mortality rate.
Nearly three-quarters of Samoans were vaccinated during the 2019 outbreak, including many adults and teenagers who had already had two doses of MMR. Originally an MMR vaccine manufactured by the Serum Institute of India was used. Unicef reported that 100,000 doses of a vaccine which contained only measles and rubella were also supplied to Samoa. Tamasese says that the second vaccine was sourced from Belgium, giving rise to the suspicion that the authorities either suspected or knew there was a problem with the original vaccine.
A 2018 nutrition study in Samoa found that while Samoans have plenty to eat, they are malnourished due to a poor diet, with vitamin A deficiency being a particular problem. Almost without exception the children who died came from poor families, living in crowded substandard housing with poor sanitation. Vitamin A is meant to be administered alongside measles vaccines, but this did not arrive in Samoa until mid-November, and little of it was actually used. Even in industrialised countries it is given in large doses to measles patients.
The local medical staff were giving the sick children Panadol and putting them in wet nappies and cold baths to reduce their fever. Tamasese says one child was given so much paracetamol it vomited blood. Antibiotics were given in an attempt to ward off secondary infections, a practice that may have made it more likely that complications would set in. ‘By the time the children were handed over to doctors from Australia and New Zealand it was too late,’ says Tamasese. ‘They were being primed for failure.’
By the time Samoa was locked down on December 5 and 6, journalists were flying in from around the world to cover the outbreak. Amongst them, filing for the Telegraph, was Brian Deer, the journalist whose campaign concerning Dr Andrew Wakefield led to the doctor being struck off in 2010.
Edwin Tamasese’s arrest on the first day of the lockdown gave the assembled journalists additional fodder. Having twice been warned by the local police to stop speaking out against the vaccination campaign, he was charged with incitement against the government after posting on Facebook, ‘Enjoy your killing spree. I’ll keep mopping up after you.’
When his case came to trial in December 2020, the judge was also the coroner presiding over the inquests. The prosecution put up a single witness against Tamasese, a nurse with a sick child, whom he’d entered the ward with to give the child vitamin A and vitamin C. Tamasese says the judge started questioning the witness herself.
It emerged that the witness had given her child the vitamins recommended by Edwin Tamasese, had stopped giving it all the hospital medication and her child had recovered.
‘The judge dismissed the witness after my lawyer said she didn’t have any questions,’ said Tamasese. ‘When the witness left the room, the judge turned to the prosecution lawyer and asked her: ‘This is your witness? That witness may as well have represented the accused!’ The judge dismissed the case, saying Tamasese had no case to answer. The public health authorities, on the other hand, have plenty.
